2017/04/01 by Nadya E. York, Nadya York, Casey A. Dauw +2 · 1 citation
Medicine · Biochemistry, Genetics and Molecular Biology · #Prostate Cancer Diagnosis and Treatment #Sexual Differentiation and Disorders #Urinary Bladder and Prostate Research
paper · doi:10.1016/j.juro.2017.02.1413
You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-08 “TOP-DOWN” HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) TECHNIQUE Nadya E. York, Casey A. Dauw, Michael S. Borofsky, and James E. Lingeman Nadya E. YorkNadya E. York More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Michael S. BorofskyMichael S. Borofsky More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1413AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video, we demonstrate our version of the novel anterior-posterior HoLEP dissection technique. METHODS Video of the surgical technique accompanied by slides and voiceover explanation of the steps RESULTS A novel anterior-posterior HoLEP dissection technique allows faster operation time and potential continence improvement. We demonstrate our version of this technique and present early operative outcomes. After cystoscopy a posterior groove is created at the 6 o'clock position in a bilobar gland. If there is a prominent median lobe the groove is cut at either 5 or 7 o'clock. The groove is extended to the veramontanum and to depth of capsule. The edges of the lateral lobes on either side of the veru are incised. The scope is rotated to visualize the anterior commissure and retracted to identify the edge of the lateral lobes and the sphincter. The anterior commissure is then incised at 2 Joules/20 Hz Setting. The dissection plane is located anteriorly with a series of short incisions. We identify this plane on both sides at this point as it can be difficult to find it later once a lateral lobe is completely resected on one side. Once the plane is apparent, lateral lobe dissection is begun. The lateral lobe is dissected from the top down, allowing faster dissection time than the traditional technique. The mucosal strip is easily visualized as the apical dissection is performed from top down. This eliminates the need to encircle the mucosal strip reducing enucleation time. Given sphincter proximity, 2 Joules/20 Hz laser setting is again used. Once the entire lobe dissection is completed, the lobe is pushed into the bladder. The residual cavity is inspected and hemostasis controlled. Finally, tissue is morcellated with a Wolf PIRANHA instrument. Retrospective review of HoLEPs from December 2015 to April 2016 was performed. 49 patients who underwent anterior posterior technique were compared with 37 who underwent traditional posterior to anterior enucleation. Mean enucleation time and mean enucleation rate were both faster with the novel, top-down approach. CONCLUSIONS We demonstrate a novel top-down HoLEP enucleation technique with promising early operative results. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e601 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nadya E. York More articles by this author Casey A. Dauw More articles by this author Michael S. Borofsky More articles by this author James E. Lingeman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...